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HomeMy WebLinkAbout10644 • -" CITY OF DIAMOND BAR � COMMUNITY DEVELOPMENT DEPARTMENT -,.w � 21660 E.Coplcy Drivc Suite 190 (909)860-3195 E'ax(909)861-3117 PRESS '""°, BUILDING PERMIT APPLICATION FIRMLY �� JOBSITE 4Lf�� �`�/ �� �@JY,Q � ��� � `( APPLICATI PERMIT �/ L� P/C o% ADDRESS /I� DATE "�_NUMBER `� � n $. ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER � ADDRESS ZONING SETBACKS �( � FRONT �'`�� z CITY ZIP TEL. �-- �� a APPLICANT TEL._ REAR n SIDE/SIDE STREET�Fl,W� ❑ �� CONTRACTOR S� � B.� SIDE s � ❑ ADDflESS � a� � CITY I�i�?�ffC%f!L_ ZIP�I6•dJ�` TELP�f/����ir,� PROPOSED USE o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a. ADDRESS � CITY ZIP TEL. UNITS STORIES _ BEDROOMS__ cn cn. DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � OWNER-BL'ILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIPM UNDER PENALN OF PERJURY THAT I AM EXEMPT FROA1 THE CONTRAC70R5 LI- Gaf8J6/C31po12 W CEN5ELAWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCOOE:ANYCITYOR (n U COUNTYWFiICHREOt11RE5APERAfITTOCON57FiUC7,pLTEfi,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- w TURE.PRIOR TO ITS ISSUANCE,AL&O REOUIR[S THE APPLICANT FOfl SUCH PERMIT TO FILE A SIONED W Pflf10/DBCi( � 37A7EMENT 7HAT NE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS tl- LL �. CENSE LAW(CHAGTER B(CAMMENCINQ YJITH SECTION 7000)OF DIVISION 30F THE Bl1SINESS AND PRO- POOUSpB O FESSIONSCODE�OATHATHEORSHFISEXEMPTTHEREFROMANDTHEBASISFORTHETLLE�EDEXEMP� (� ` V TION.ANYVIOLATIONOFSECTION7031.5BYANYAPPiICANTFOAAPERMITSU&IECTSTHEAPP�ICANTTO Z Re-Roof p � A CNIL PENpLTY OF NOTMORE THAN FIVE HUN�RED DOLLARS�SSoo)J: g I]I,AS OWNER OFTHE PHOPERN,OR AIV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, � 0 Commercial € Z WILL DO THE WORK,ANO THE STRUCTURE IS NOT INTENDEO OR OFFF.RED FOR SALE(SEC.lOa4,BUSI- J � � NESSAND PflOFES510NS CODE:TNE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � OROPERTY NhlO BUILDS OR IAIPROVES TVIEREON,AND NM110 DOES SUCH WORK HIMSELF OR HERSELF OR � TNRWOHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROYEMENTSAqENOTMITEN�EDOP m O OFFEREOWFlSALE.IF,HOWEVER,7FfEBU1lDINGONIMPROVEMENTIS501DWITHINONEYEAROFCOMPLE- � Z TbN,THE OWNER�9UILOER WILL HAVE THE BUHDEN OF PROVING THAi HE OF SHE DID NOT 9UILD OR � IMPROVEFORTHEPUflPO3EOFSALE). W CJI,ASOWNEROFTMEPflOPEfliY,AME%CLUSIVELYfANTHACTINGWI7HLICENSEDCONTRACTONS � TO CANSTFUCT THE PRQIECT(SEC.70<4,BUSINESS ANO PROFESSIONS CODE:TNE CONTRACTORS ll- V8IU8�i0n ADJ.AREA W CENSELAWOOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROYESTHEREDN.AND ------ = WFiOGONTRACT5FOR5UCHPR0.IECTSWITHACANTRACTOR�S�LICENSE�PURSUANTTOTHEO�NTqAG QUANTITY DESCRIPTION FEE Y TORSIICENSEUW.). � ❑I AM EXEMPT UNDER SEC. B.&P.C.FOR TMIS qEA50N J O V 3 — � � DATE ____,__ OWNER 1"' , � W � LICENSED CONTRACTORS DECLARATION W ¢ � I NEREBY AFFIRM UNDER PENALN OF PERJURY THAT IAM UCENSED UNDEFl PROVISIONS OF CNAPTER � d 9(COMMENCINO WITH SECTION 7000)OF OIVISION 3 OF THE BIISINE55 AND PpOFESSiONS CADE.AND Z ' X AIY UCENSE IS M FULL FORCE AN�EFFECT. � � LICENSE C/I,�qSS������ LIC.NO. ' � _,�r—___ � V DATE U � "���CONTRACTOP � �iA ___ a W � WORKERS'COMPENSATION DECLARATION a � . . �. G � IHERE9VAFFIRAIl1N�ERPENALTYDFPERJURYONEOFTHEFOLLOWING�ECLAPATIONS: Z •py�/�.�y� e_{ j__ y` _� � yCr.,��Y1s l L��I 1" r � I HAVE AND WILL MAINTAIN A CER7IFICATE OF CONSEM TO SELF�INSURE FOR WORKERS' -�{� Q COIAPENSATION,ASPROVIOEDBVSECTION37ooOFTHEIABORCA�E,FORTHEPERFORAIANCE U �� � - � �- 5 Z1 T .J '�/�' Q �H.ff�F TME WORK FOR WNICH THIS PERMIT IS IS5UED. � W �IHAVEANDWILlMA1NTAINWOPKER3'COMPENSATIONINSURANCE,ASflEOUIRE08Y5ECTION Q 3700 OFTHE LABOR COUE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MYW RKERS'COMPENSATIO�N+INS PANCECARTRIERAN�DPO/LICyNUMBERARE: CONSTRUCTION � CARRIER�����✓�T���J`�.-ta�e.'; �L+,. PLANREVIEW --. Zroucv NUMsea_,.�.(a�___ —_ ELECTRIC ___ ___ ¢ 0 (ni�ss[cnavNEmr+oraEmrne�rEnoFn�rEw�xr�sroaavetnx�vr�ooat.uts(S�oo�or��Ess�. PLUMBING Z ICEH7I�VTHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUFD,1 MECHANICAL _ ��� ' � CS SHPLL NOT EMPLOV PNY PEft50N IN ANY MANNER SOAS TO BEWME SUBJECT TO THL � WOHKEtiS'fAMPENSATIONLAW50FCALIFORNIA.AN0A6REETHATIFISHOULDBECOME INSPECTIONFEE __ SU6JECT TO TNE WORNERS'CAAIPENSATION PROVISI S OF SECTION]�a00F THE IADOR � CO I SMALL FORTHWITHCOM�LV WI SE ioNs. ISSUANCE !'� • t/ G p DATE:�i����APPUCANT, �� r'��_ '_'___ SMIP fw��� � ��� � � ENERGY P/C � ��'����� J WApNINO:FAILURE TO SECUFE WORKERS'COMPENSATIO COVEflAGE IS UNIAWFUL,AND SHALLBE — �- � SUBJECTANEMPLOYERTOCRIMWALPENPLTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f100.000).IN A�DITION TO THE COSTOF COMPENSATION,�AMAGESAS PROVI�E�FOR IN � SECTION 37080F THE LABOR CADE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: I F` _ O CONSTRUCTION LENDING AGENCY �R" � PRE•ALT FEE: � 1 HERFHV AFFIRM UNDEfl PENALTY OF PERJURY THAT THERE IS A CANSTRUCTION LENDING AOENCY fOR THE PERFOflMANCE Oi 7HE WORK FOR Y7HICH THIS PEfiMIT IS ISSUED�SEC.3097,CIV.C). Z W — � LENDER'SNAME__"__'___'_"_______-__—_'_ f-- LENDEH'S nDORESS_ ^� � ICERTIFYTHATIHAVEREADTHISAPPUCATIONANDSTA7ETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES � I•� •�� a w 1 AOREE TO COMPLY WITH ALLqTY ANO COUNTV ORDINANCESAND STATE LAWS REUTING TO BUILDING � CONSTRUCTION,ANDHEREBYAUTHOfiIZEFEPRESENTATNE50FTF115CAUNTYTOENTERUPONTHE ZA80VE-IJENTIONE�ONOGERTV FOR INSPECTION PUHPOSES. 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